Provider Demographics
NPI:1225239429
Name:COLUMBIA COUNTY SENIOR SERVICES
Entity Type:Organization
Organization Name:COLUMBIA COUNTY SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-755-0235
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-1772
Mailing Address - Country:US
Mailing Address - Phone:386-755-0235
Mailing Address - Fax:386-752-8256
Practice Address - Street 1:628 SE ALLISON CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6101
Practice Address - Country:US
Practice Address - Phone:386-755-0235
Practice Address - Fax:386-752-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No332U00000XSuppliersHome Delivered MealsGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024881902Medicaid
FL024881900Medicaid
FL688862300Medicaid